Recently the government of Oman has made the law mandatory for premarital medical screening to deal with hereditary diseases, particularly blood disorders including sickle cell anaemia and beta-thalassemia etc. Starting in 2026, this initiative will become mandatory.  It is part of the ministry of Oman’s long-standing efforts to improve public health. Since 1999, premarital screening has been part of its primary health protection strategy. According to statistics around 7 percent of children in the world are born with hereditary diseases, but Oman has a higher prevalence of hereditary diseases with 9-10% of children born with these conditions due to blood-related marriages.

This is not only to maintain hereditary diseases but also to prevent the propagation of contagious diseases if planned thoroughly. In a wide sense, prospective married couples can participate in a premarital genetic screening to reduce the possibility of passing on certain genetic, infectious, and blood-transmitted disorders to their children, as well as to minimize congenital anomalies and various medical, psychological, and marital problems between themselves. Nowadays, premarital screening laws are becoming more prevalent around the world.

So, Premarital screening laws may have been proposed to limit the spread of certain hereditary and STD diseases by requiring individuals to undergo medical tests and be informed of any potential health risks before marriage through medical testing; however, their implementation has given rise to a global dilemma. Some argue it is an infringement of fundamental liberty, the right to marry, the implications of involuntary withdrawal of blood, and conflicts with religious principles. However, we can see that the implementation of premarital medical examination laws in Arabic-Muslim nations has produced favourable results in Bahrain, Palestine, the United Arab Emirates, and Saudi Arabia, while having little effect in Egypt, Kuwait, or Tunisia.

Early in Europe, the Scandinavian countries were the first to require mandatory prenuptial health examinations. According to the Swedish Marriage Act of 1915, “those having the venereal disease in a contagious stage, the feeble-minded and the insane or epileptic did not have the right to marry, and fiancées had to submit medical certificates. A similar Act was adopted in Norway in 1918, where people who suffered from contagious syphilis could not get married.  The main aim of the marriage laws from the beginning of the 20th century was “to delay marriages until the infected persons received proper treatment or passed the contagious stage of syphilis, not to prevent marriages.”  These were the so-called positive eugenic laws. They were different from the negative eugenic laws that, after Adolf Hitler’s power, prohibited marriage and family life for individuals with eugenically undesirable characteristics, including sexual segregation, sterilization, and euthanasia, based on race, nationality, and ethnicity.

Throughout the Mediterranean region, the Middle East, tropical Africa, and the Caribbean, the Indian subcontinent, including Bangladesh, South-East Asia these illnesses pose a serious threat to public health. In Asia, voluntary premarital screening programs for hereditary and STDs have been implemented in nations like China, Taiwan, Malaysia, India, Indonesia, the Maldives, Singapore, and Thailand; however, there is no data on premarital screening programs in Bangladesh, Pakistan, Nepal, Sri Lanka, and Bhutan.

Although Bangladesh has improved in several areas of health since 1972, such as life expectancy, infant mortality, and access to healthcare, it still lags far behind many other nations, especially India, our neighbour, in terms of genetic services. Thalassemia and hemoglobinopathies are prevalent hereditary genetic diseases in Bangladesh that significantly increase morbidity and mortality while also placing a substantial financial strain on our community.

The question inevitably arises whether Bangladesh should go with mandatory premarital medical screening or whether the government should prioritize promoting voluntary participation through awareness programs and incentives. So, based on this very fundamental question, it depends on whether a law or policy should be enacted. From this understanding, premarital medical screening might be lexically linked to ‘counselling’ to increase acceptability and compliance, presenting it as a thorough health and advising procedure rather than a merely obligatory one.

There are numerous instances of government medical interventions in Bangladesh focusing on proactive measures to prevent health complications. These include essential procedures like routine childhood immunizations, prenatal care for pregnant women, postpartum checks for mothers, family planning services for couples, and communicable disease screening for diseases like tuberculosis, HIV/AIDS, and hepatitis. Notably, we have the National Maternal Health Strategy 2019-30. Additionally, routine childhood immunizations fall under the Vaccination Act, 1880, with compulsory vaccination for children protecting from preventable illnesses like tuberculosis, polio, measles, diphtheria, pertussis, tetanus, and hepatitis B. The government of Bangladesh has been working for a long time to accomplish the SDG, especially goal 3, which is about good health and well-being. Its main objectives include universal health coverage, infectious and non-communicable diseases, and reproductive, maternal, newborn, child, and adolescent health. Our rising phenomena of implementing premarital medical screening & counselling are very much like this objective also.  Many nations now have laws for premarital medical screening. Most of these regulations require an in-person test of the prospective bride and groom before a marriage license can be issued.

So, as we already know, premarital medical screening currently is not required by any law in Bangladesh. However, if there were a drive to make it necessary, the next actions—to comply—would undoubtedly require new legislation or an amendment to the laws governing marriage. In Bangladesh, the primary laws governing marriage, particularly registration —the Muslim Marriages and Divorces (Registration) Act, 1974; the Hindu Marriage Registration Act, 2012; the Christian Marriage Act, 1872; and the Special Marriage Act, 1872. So, by amending this existing legislation, it could include mandatory premarital medical screening as a prerequisite for marriage registration. Or a submit of a medical certificate from prospective couples could be part of the registration process also.

Till now, Bangladesh’s legal regime does not incorporate explicit provisions related to premarital health screening, unlike Contemporary Islamic laws in some countries, such as Saudi Arabia and Malaysia, which have introduced such measures, and some Christian-majority countries, like the U.S., also mandates such screenings. Therefore, if we examine the literature on premarital medical screening compliance in many countries throughout the world, we can see whether it is incorporated into the nation’s marriage act or into a new legal corpus such as a “Premarital Medical Screening Act” or “Premarital Health Examination Legislation.” Bangladesh could consider enacting dedicated legislation like that. The implementation of premarital screening programs in Bangladesh can be severely hindered by a lack of resources and qualified medical genetics specialists. In addition, illiteracy, cultural norms, religious views, and social practices may be further obstacles to implementing premarital screening programs in Bangladesh. However, it is imperative to launch pilot projects and motivating campaigns to introduce premarital screening programs to lower the prevalence of inherited genetic illnesses, particularly hemoglobinopathies and thalassemia.